Transgender people are people who have a gender identity, or gender expression, that differs from their assigned sex.[1][2][3] Transgender people are sometimes called transsexual if they desire medical assistance to transition from one sex to another. Transgender is also an umbrella term: in addition to including people whose gender identity is the opposite of their assigned sex (trans men and trans women), it may include people who are not exclusively masculine or feminine (people who are genderqueer, e.g. bigender, pangender, genderfluid, or agender).[2][4][5] Other definitions of transgender also include people who belong to a third gender, or conceptualize transgender people as a third gender.[6][7] Infrequently, the term transgender is defined very broadly to include cross-dressers,[8] regardless of their gender identity.

Being transgender is independent of sexual orientation:[9] transgender people may identify as heterosexual, homosexual, bisexual, asexual, etc., or may consider conventional sexual orientation labels inadequate or inapplicable. The term transgender can also be distinguished from intersex, a term that describes people born with physical sex characteristics "that do not fit typical binary notions of male or female bodies".[10]

Evolution of transgender terminology

Psychiatrist John F. Oliven of Columbia University coined the term transgender in his 1965 reference work Sexual Hygiene and Pathology, writing that the term which had previously been used, transsexualism, "is misleading; actually, 'transgenderism' is meant, because sexuality is not a major factor in primary transvestism."[18][19] The term transgender was then popularized with varying definitions by various transgender, transsexual and transvestite people, including Virginia Prince,[20] who used it in the December 1969 issue of Transvestia, a national magazine for cross dressers she founded.[21] By the mid-1970s both trans-gender and trans people were in use as umbrella terms,[note 1] and 'transgenderist' was used to describe people who wanted to live cross-gender without sex reassignment surgery (SRS).[22] By 1976, transgenderist was abbreviated as TG in educational materials.[23]

By 1984, the concept of a "transgender community" had developed, in which transgender was used as an umbrella term;[24] in 1985, Richard Elkins established the "Trans-Gender Archive" at the University of Ulster.[21] By 1992, the International Conference on Transgender Law and Employment Policy defined transgender as an expansive umbrella term including "transsexuals, transgenderists, cross dressers" and anyone transitioning.[25]

The term trans man refers to a man who has transitioned from female to male, and trans woman refers to a woman who has transitioned from male to female. Health-practitioner manuals, professional journalistic style guides, and LGBT advocacy groups advise the adoption by others of the name and pronouns identified by the person in question, including present references to the transgender person's past;[26][27] many also note that transgender should be used as an adjective, not a noun (for example, "Max is transgender" or "Max is a transgender man", not "Max is a transgender"), and that transgender should be used, not transgendered.[28][29][30]

Transsexual and its relationship to transgender

The term transsexual was introduced to English in 1949 by David Oliver Cauldwell,[note 2] and popularized by Harry Benjamin in 1966, around the same time transgender was coined and began to be popularized.[20] Since the 1990s, transsexual has generally been used to describe the subset of transgender people[20][32][33] who desire to transition permanently to the gender with which they identify and who seek medical assistance (for example, sex reassignment surgery) with this. However, the concerns of the two groups are sometimes different; for example, transsexual men and women who can pay for medical treatments (or who have institutional coverage for their treatment) are likely to be concerned with medical privacy and establishing a durable legal status as their gender later in life.

Distinctions between the terms transgender and transsexual are commonly based on distinctions between gender (psychological, social) and sex (physical).[34][35] Hence, transsexuality may be said to deal more with material aspects of one's sex, while transgender considerations deal more with one's internal gender disposition or predisposition, as well as the related social expectations that may accompany a given gender role.[36] Many transgender people prefer the designation transgender and reject transsexual.[37][38][39] For example, Christine Jorgensen publicly rejected transsexual in 1979, and instead identified herself in newsprint as trans-gender, saying, "gender doesn't have to do with bed partners, it has to do with identity."[40][41] This refers to the concern that transsexual implies something to do with sexuality, when it is actually about gender identity.[42][note 3] Some transsexual people (those who desire or have undergone), however, object to being included in the transgender umbrella.[43][44][45][46] The definitions of both terms have historically been variable.

In his 2007 book Transgender, an Ethnography of a Category, anthropologist David Valentine asserts that transgender was coined and used by activists to include many people who do not necessarily identify with the term, and states that people who do not identify with the term transgender should not be included in the transgender spectrum.[43] Leslie Feinberg likewise asserts that transgender is not a self-identifier (for some people) but a category imposed by observers to understand other people.[44] However, these assertions are contested by the Transgender Health Program (THP) at Fenway Health in Boston. It notes that there are no universally accepted definitions, and terminology confusion is common because terms that were popular in at the turn of the 21st century may now be deemed offensive. The THP recommends that clinicians ask clients what terminology they prefer, and avoid the term transsexual unless they are sure that a client is comfortable with it.[42]

Harry Benjamin invented a classification system for transsexuals and transvestites, called the Sex Orientation Scale (SOS), in which he assigned transsexuals and transvestites to one of six categories based on their reasons for cross-dressing and the relative urgency of their need (if any) for sex reassignment surgery.[47] Benjamin considered a moderate intensity "true transsexual" to need either estrogen or testosterone as a "substitute for or preliminary to operation";[47] people who meet Benjamin's definition of a "true transsexual" but do not desire SRS include Miriam Rivera. There are also people who have had SRS but do not meet the definition of "transsexual", such as Gregory Hemingway.[48][49]

Other categories

In addition to trans men and trans women whose binary gender identity is the opposite of their assigned sex, and who form the core of the transgender umbrella, being included in even the narrowest definitions of it, several other groups are included in broader definitions of the term. These include people whose gender identities are not exclusively masculine or feminine but may, for example, be androgynous, bigender, pangender or agender — often grouped under the alternative umbrella term genderqueer[5] — and third-gender people (alternatively, some references and some societies conceptualize transgender people as a third gender).[6][7] Although some references define transgender very broadly to include transvestites / cross-dressers,[8] they are usually excluded, as are transvestic fetishists (because they are considered to be expressing a paraphilia rather than a gender identification) and drag kings and drag queens (who are performers and cross-dress for the purpose of entertaining).

Genderqueer, including androgynous and bigender

Genderqueer or non-binary identities, which are not exclusively masculine or feminine but instead are agender, androgynous, bigender, pangender or genderfluid,[50] exist outside of cisnormativity.[51][52] Bigender and androgynous are overlapping categories; bigender individuals may identify as moving between male and female roles (genderfluid) or as being both male and female simultaneously (androgynous), and androgynes may similarly identify as beyond gender or genderless (postgender, agender), between genders (intergender), or moving across genders (genderfluid) or simultaneously exhibiting multiple genders (pangender). Limited forms of androgyny are common (women wearing pants, men wearing earrings) and are not seen as transgender behaviour. Androgyne is also sometimes used as a medical synonym for an intersex person.[53] Genderqueer identities are independent of sexual orientation.

Transvestite or cross-dresser

A transvestite is a person who cross-dresses, or dresses in clothes typically associated with the gender opposite the one they were assigned at birth.[54][55] The term transvestite is used as a synonym for the term cross-dresser,[56][57] although cross-dresser is generally considered the preferred term.[57][58] The term cross-dresser is not exactly defined in the relevant literature. Michael A. Gilbert, professor at the Department of Philosophy, York University, Toronto, offers this definition: "[A cross-dresser] is a person who has an apparent gender identification with one sex, and who has and certainly has been birth-designated as belonging to [that] sex, but who wears the clothing of the opposite sex because it is that of the opposite sex."[59] This definition excludes people "who wear opposite sex clothing for other reasons," such as "those female impersonators who look upon dressing as solely connected to their livelihood, actors undertaking roles, individual males and females enjoying a masquerade, and so on. These individuals are cross dressing but are not cross dressers."[60] Cross-dressers may not identify with, or want to be the opposite gender, nor adopt the behaviors or practices of the opposite gender, and generally do not want to change their bodies medically. The majority of cross-dressers identify as heterosexual.[61] People who cross-dress in public can have a desire to pass as the opposite gender, so as not to be detected as a cross-dresser, or may be indifferent.

The term transvestite and the associated outdated term transvestism are conceptually different from the term transvestic fetishism, as transvestic fetishist describes those who intermittently use clothing of the opposite gender for fetishistic purposes.[62][63] In medical terms, transvestic fetishism is differentiated from cross-dressing by use of the separate codes 302.3[63] in the DSM and F65.1[62] in the ICD.

Drag kings and queens

Drag is a term applied to clothing and make-up worn on special occasions for performing or entertaining, unlike those who are transgender or who cross-dress for other reasons. Drag performance includes overall presentation and behavior in addition to clothing and makeup. Drag can be theatrical, comedic, or grotesque. Drag queens have been considered caricatures of women by second-wave feminism. Drag artists have a long tradition in LGBT culture. Generally the terms drag queen covers men doing female drag, drag king covers women doing male drag, and faux queen covers women doing female drag. Nevertheless, there are drag artists of all genders and sexualities who perform for various reasons. Some drag performers, transvestites, and people in the gay community, have embraced the pornographically-derived term tranny to describe drag queens or people who engage in transvestism or cross-dressing; however this term is widely considered offensive if applied to transgender people.[64]

Intersex

Intersex people have genitalia or other physical sex characteristics that do not conform to strict definitions of male or female, but intersex people are not necessarily transgender because they do not necessarily disagree with their assigned sex. Transgender and intersex issues often overlap, however, because they may both challenge rigid definitions of sex and gender.

LGBT community

The concepts of gender identity and transgender identity differ from that of sexual orientation.[65] Sexual orientation describes an individual's enduring physical, romantic, emotional, or spiritual attraction to another person, while gender identity is one's personal sense of being a man or a woman.[28] Transgender people have more or less the same variety of sexual orientations as cisgender people.[66] In the past, the terms homosexual and heterosexual were incorrectly used to label transgender individuals' sexual orientation based on their birth sex.[67] Professional literature now uses terms such as attracted to men (androphilic), attracted to women (gynephilic), attracted to both (bisexual) or attracted to neither (asexual) to describe a person's sexual orientation without reference to their gender identity.[68] Therapists are coming to understand the necessity of using terms with respect to their clients' gender identities and preferences.[69] For example, a person who is assigned male at birth, transitions to female, and is attracted to men would be identified as heterosexual.

Despite the distinction between sexual orientation and gender, throughout history the gay, lesbian, and bisexual subculture was often the only place where gender-variant people were socially accepted in the gender role they felt they belonged to; especially during the time when legal or medical transitioning was almost impossible. This acceptance has had a complex history. Like the wider world, the gay community in Western societies did not generally distinguish between sex and gender identity until the 1970s, and often perceived gender variant people more as homosexuals who behaved in a gender-variant way than as gender-variant people in their own right. Today, members of the transgender community often continue to struggle to remain part of the same movement as lesbian, gay and bisexual citizens, and to be included in rights protections. And in fact, the role of the transgender community in the history of LGBT rights is often overlooked, as shown in Transforming History.[70]

Healthcare

Mental healthcare

Most mental health professionals recommend therapy for internal conflicts about gender identity or discomfort in an assigned gender role, especially if one desires to transition. People who experience discord between their gender and the expectations of others or whose gender identity conflicts with their body may benefit by talking through their feelings in depth; however, research on gender identity with regard to psychology, and scientific understanding of the phenomenon and its related issues, are relatively new.[71] The terms transsexualism, dual-role transvestism, gender identity disorder in adolescents or adults and gender identity disorder not otherwise specified are listed as such in the International Statistical Classification of Diseases (ICD) or the American Diagnostic and Statistical Manual of Mental Disorders (DSM) under codes F64.0, F64.1, 302.85 and 302.6 respectively.[72] The DSM-5 refers to the topic as gender dysphoria.

Transgender people may meet the criteria for a diagnosis of gender identity disorder (GID) "only if [being transgender] causes distress or disability."[73] This distress is referred to as gender dysphoria and may manifest as depression or inability to work and form healthy relationships with others. This diagnosis is often misinterpreted as implying that transgender people suffer from GID; this misinterpretation has greatly confused transgender people and those who seek to either criticize or affirm them. Transgender people who are comfortable with their gender and whose gender is not directly causing inner frustration or impairing their functioning do not suffer from GID. Moreover, GID is not necessarily permanent and is often resolved through therapy or transitioning. Feeling oppressed by the negative attitudes and behaviors of such others as legal entities does not indicate GID. GID does not imply an opinion of immorality; the psychological establishment holds that people with any kind of mental or emotional problem should not receive stigma. The solution for GID is whatever will alleviate suffering and restore functionality; this solution often, but not always, consists of undergoing a gender transition.[71]

Clinical training lacks relevant information needed in order to adequately help transgender clients, which only produces a series of practitioners who are not prepared to sufficiently work with this population of individuals.[74] Many mental healthcare providers know little about transgender issues. Those who seek help from these professionals often educate the professional without receiving help.[71] Many therapists who profess to know about transgender issues believe that transitioning from one sex to another – the standard transsexual model – is the best or only solution.[citation needed] This solution usually is good for transsexual people but is not the solution for other transgender people, particularly genderqueer people who lack an exclusively male or female identity. Instead, therapists can support their clients in whatever steps they choose to take to transition or support their decision to not transition while also addressing their clients' sense of congruence between gender identity and appearance.[11]

Acknowledgment of the lack of clinical training has increased; however, research on the specific problems faced by the transgender community in mental health has focused on diagnosis and clinicians' experiences instead of transgender clients' experiences.[75] Therapy was not always sought out by people due to mental health needs. Prior to the seventh version of the Standards of Care (SOC), an individual had to be diagnosed with gender identity disorder in order to proceed with hormone treatments or sexual reassignment surgery. The new version decreased the focus on diagnosis and instead emphasized the importance of flexibility in order to meet the diverse health care needs of transsexual, transgender, and all gender nonconforming people.[76]

The purposes for seeking mental health services vary according to the individual, and simply because a transgender person seeks treatment does not mean their gender identity is problematic. The emotional strain on dealing with stigma and experiencing transphobia pushes many transgender people to seek treatment to improve their quality of life, as one transwoman reflected: "Transgendered individuals are going to come to a therapist and most of their issues have nothing to do, specifically, with being transgendered. It has to do because they've had to hide, they've had to lie, and they've felt all of this guilt and shame, unfortunately usually for years!"[75] Struggling to deal with the stigma still attached to identifying as transgender, many people also seek mental health treatment for depression and anxiety, and some transgender people have stressed the importance of acknowledging their gender identity with a therapist in order to discuss other quality of life issues.[75]

Problems still remain surrounding misinformation about transgender issues that hurt transgender people's mental health experiences. One transman who was enrolled as a student in a psychology graduate program highlighted the main concerns with modern clinical training: "Most people probably are familiar with the term transgender, but maybe that's it. I don’t think I've had any formal training just going through [clinical] programs . . . I don’t think most [therapists] know. Most therapists—Master's degree, PhD level—they've had . . . one diversity class on GLBT issues. One class out of the huge diversity training. One class. And it was probably mostly about gay lifestyle."[75] Many health insurance policies do not cover treatment associated with gender transition, and numerous people are under or not insured, which raises concerns about the insufficient training most therapists receive prior to working with transgender clients, potentially increasing financial strain on clients without providing the treatment they need.[75] Many clinicians who work with transgender clients only receive mediocre training on gender identity, but introductory training on interacting with transgender people has recently been made available to health care professionals to help remove barriers and increase the level of service for the transgender population.[77]

The issues around psychological classifications and associated stigma (whether based in paraphilia or not) of cross dressers, transsexual men and women (and lesbian and gay children, who may resemble trans children early in life) have become more complex since CAMH (Centre for Addiction and Mental Health) colleagues Kenneth Zucker and Ray Blanchard were announced to be serving on the DSM-V's Sexual and Gender Identity Disorders Work Group.[78] CAMH aims to 'cure' transgender people of their 'disorder', especially in children. Within the trans community, this intention has mostly produced shock and outrage with attempts to organize other responses.[79] In February 2010, France became the first country in the world to remove transgender identity from the list of mental diseases.[80][81]

Trans men who have not had a hysterectomy and who take testosterone are at increased risk for endometrial cancer because androstenedione, which is made from testosterone in the body, can be converted into estrogen, and external estrogen is a risk factor for endometrial cancer.[84]

Law

Camille Cabral, a French transgender activist at a demonstration for transgender people in Paris, October 1, 2005

Legal procedures exist in some jurisdictions, allowing individuals to change their legal gender or name to reflect their gender identity. Requirements for these procedures vary from an explicit formal diagnosis of transsexualism to a diagnosis of gender identity disorder to a letter from a physician that attests the individual's gender transition or having established a different gender role.[85] In 1994, the DSM IV entry was changed from "Transsexual" to "Gender Identity Disorder." In many places, transgender people are not legally protected from discrimination in the workplace or in public accommodations.[17] A report released in February 2011 found that 90% of transgender people faced discrimination at work and were unemployed at double the rate of the general population.[15] Over half had been harassed or turned away when attempting to access public services.[15] Members of the transgender community also encounter high levels of discrimination in health care on an everyday basis.[86]

In Canada, a private members bill protecting the rights of freedom of gender expression and gender identity passed in the House of Commons on February 9, 2011. It amends the Canada Human Rights code to help protect gender-variant people from discrimination by including gender identity and expression in the list of prohibited grounds for discrimination, as well as including gender identity and expression in the description of identifiable group, so that offences deliberately against gender-variant people can be punished to a similar extent as a racial-based crime.[87] The bill may or may not be passed by the Senate.[88]

In the United States, a federal bill to protect workers from discrimination based on sexual orientation and gender identity—called the Employment Non-Discrimination Act—has stalled and failed several times over the past two decades.[89] Still, individual states and cities have begun passing their own non-discrimination ordinances. In New York, for example, Governor David Paterson passed the first legislation to include transgender protections in September 2010.[90]

Nicole Maines, a trans girl, took a case to Maine's Supreme Court in June, 2013. She argued that being denied access to her high school's women's restroom was a violation of Maine's Human Rights Act; one state judge has disagreed with her,[91] but Maines won her lawsuit against the Orono school district in January 2014 before the Maine Supreme Judicial Court.[92]

In April 2014, the Supreme Court of India declared transgender to be a 'third gender' in Indian law.[94][95][96] The transgender community in India (made up of Hijras and others) has a long history in Indian history and in Hindu mythology.[97][98] Justice KS Radhakrishnan noted in his decision that, "Seldom, our society realizes or cares to realize the trauma, agony and pain which the members of Transgender community undergo, nor appreciates the innate feelings of the members of the Transgender community, especially of those whose mind and body disown their biological sex", adding:

Non-recognition of the identity of Hijras/transgender persons denies them equal protection of law, thereby leaving them extremely vulnerable to harassment, violence and sexual assault in public spaces, at home and in jail, also by the police. Sexual assault, including molestation, rape, forced anal and oral sex, gang rape and stripping is being committed with impunity and there are reliable statistics and materials to support such activities. Further, non-recognition of identity of Hijras /transgender persons results in them facing extreme discrimination in all spheres of society, especially in the field of employment, education, healthcare etc.

Hijras/transgender persons face huge discrimination in access to public spaces like restaurants, cinemas, shops, malls etc. Further, access to public toilets is also a serious problem they face quite often. Since, there are no separate toilet facilities for Hijras/transgender persons, they have to use male toilets where they are prone to sexual assault and harassment. Discrimination on the ground of sexual orientation or gender identity, therefore, impairs equality before law and equal protection of law and violates Article 14 of the Constitution of India.[99]

Transgender people are also prohibited from serving in the US military, but United States Secretary of Defense Chuck Hagel is quoted as stating that the military should "continually" review its prohibition on transgender individuals and stating: "Every qualified American who wants to serve our country should have an opportunity if they fit the qualifications and can do it."[100]

Religion

James D. Whitehead and Evelyn Eaton Whitehead, educators and authors, discuss[101] the links between spirituality and sexuality, and the frequent absence of compassion within the church community, in their case, the Catholic Church, in ministering to this community.[102]

Feminism

Some feminists and feminist groups are supportive of transgender people. Others are not.

Though second-wave feminism argued for the sex and gender distinction, some feminists believed there was a conflict between transgender identity and the feminist cause; e.g., they believed that male-to-female transition abandoned or devalued female identity, and that transgender people embraced traditional gender roles and stereotypes. Many transgender feminists, however, view themselves as contributing to feminism by questioning and subverting gender norms. Third wave and contemporary feminism are generally more supportive of transgender people.[103]

Scientific studies of transsexuality

A study of Swedes estimated a ratio of 1.4:1 trans women to trans men for those requesting sex reassignment surgery and a ratio of 1:1 for those who proceeded.[104] The causes of transsexuality have been studied for decades.

The most studied factors are biological. Studies beginning with Zhou in 1995 have found that trans women's brain structure (volume and density of neurons) is similar to cisgender (cis) women's and unlike cis men's, and trans men's is similar to cis men's, even when controlling for hormone use. A 2002 study by Chung suggested significant sexual dimorphism in the BSTc did not become established until adulthood, theorizing that either changes in fetal hormone levels produce changes in BSTc synaptic density and other factors which later lead to the observed differences in BSTc, or the differences are affected by the generation of a gender identity inconsistent with assigned sex. Studies in 2004 (Swaab), 2006 (Gooran), 2008 (Garcia-Falgueras), and 2010 (Rametti) confirmed earlier research finding that gender identity is influenced by brain structure. (Brain structure differences have also been noted between gay and heterosexual men, and lesbian and heterosexual women as part of extensive research on biology and sexual orientation.) Studies have also found that both androphilic and gynephilic trans women's brain function and responses are like cis women's and unlike cis men's, or are intermediate between the two. Likewise, studies such as Rametti's have found that trans men have male-like white matter patterns (even before using hormones), regardless of sexual orientation.

With regard to genetic factors, a study by Hare reported that trans women have a longer androgen receptor gene than cis men, which is less effective at binding testosterone, potentially preventing complete masculinization of the brain. (Prenatal androgen exposure or sensitivity, or lack thereof, is often cited mechanisms to explain observed brain-structure differences.) A study by Bentz found that trans men have a CYP17 allele distribution like cis men and unlike cis women.[105] A twin study found that 33% of pairs of identical twins were both trans, compared to only 2.6% of non-identical twins who were raised in the same family at the same time, but were not genetically identical.[106]

Population figures

United States

One effort to quantify the population gave a "rough estimate" that 0.3 percent of adults in the US (1-in-300) are transgender, overlapping to an unknown degree with the estimated 3.5 percent of US adults (1-in-30) who identify as LGB.[107][108] A more recent study, released in 2016, estimated that the proportion of Americans who are transgender was 0.6%.[109][110]

Latin America

In Latin American cultures, the travestis generally undergo hormonal treatment, use female gender expression including new names and pronouns from the masculine ones they were given when assigned a sex, and might use breast implants, but they are not offered or do not desire sex-reassignment surgery, and might be regarded as a gender in itself (a "third gender"), a mix between man and woman ("intergender/androgynes") or the presence of both masculine and feminine identities in a single person ("bigender"). They are framed as something entirely separate from transgender women, who possess the same gender identity of people assigned female at birth.

Other transgender identities are becoming more widely known, as a result of contact with other cultures of the Western world.[111] These newer identities, sometimes known under the umbrella use of the term "genderqueer",[111] along with the older travesti term, are known as non-binary, and go along with binary transgender identities (those traditionally diagnosed under the now obsolete label of "transsexualism") under the single umbrella of transgender, but are distinguished from crossdressers and drag queens and kings, that are held as nonconforming gender expressions rather than transgender gender identities when a distinction is made.

Deviating from the societal standards for sexual behavior, sexual orientation/identity, gender identity and gender expression have a single umbrella term that is known as sexodiverso or sexodiversa in both Spanish and Portuguese, with its most approximate translation to English being "queer".

In India, the Supreme Court on April 15, 2014, recognized a third gender that is neither male nor female, stating "Recognition of transgenders as a third gender is not a social or medical issue but a human rights issue."[128]

On January 5, 2015, Reuters stated that the first transgender mayor was elected in central India.[129]

North America

In what is now the United States and Canada, many Native American and First Nations peoples recognised[130] the existence of more than two genders, such as the Zuñi male-bodied Ła'mana,[131] the Lakota male-bodied winkte[132] and the Mohave male-bodied alyhaa and female-bodied hwamee.[133] Such people were previously[134] referred to as berdache but are now referred to as Two-Spirit,[135] and their spouses would not necessarily have been regarded as gender-different.[133] In Mexico, the Zapotec culture includes a third gender in the form of the Muxe.[136]

Among the ancient Middle Eastern Akkadian people, a salzikrum was a person who appeared biologically female but had distinct male traits. Salzikrum is a compound word meaning male daughter. According to the Code of Hammurabi, salzikrūm had inheritance rights like that of priestesses; they inherited from their fathers, unlike regular daughters. A salzikrum's father could also stipulate that she inherit a certain amount.[142]

Mahu is a traditional status in Polynesian cultures. Also, in Fa'asamoa traditions, the Samoan culture allows a specific role for male to female transgender individuals as Fa'afafine.

Coming out

Transgender people vary greatly in choosing when, whether, and how to disclose their transgender status to family, close friends, and others. The prevalence of discrimination[143] and violence[144] against the transgender community can make coming out a risky decision. Fear of retaliatory behavior, such as being removed from the parental home while underage, is a cause for transgender people to not come out to their families until they have reached adulthood.[145] Parental confusion and lack of acceptance of a transgender child may be met with an effort to change their children back to "normal" by utilizing mental health services to alter the child's sexual orientation and what is seen as a "phase".[146]

Media representation

As more transgender people are represented and included within the realm of mass culture, the stigma that is associated with being transgender can influence the decisions, ideas, and thoughts based upon it. Media representation, culture industry, and social marginalization all hint at popular culture standards and the applicability and significance to mass culture as well. These terms play an important role in the formation of notions for those who have little recognition or knowledge of transgender people. Media depictions represent only a minuscule spectrum of the transgender group,[147] which essentially conveys that those that are shown are the only interpretations and ideas society has of them. Elliot Fletcher, a transgender teen, has been cast as the first transgender character in MTV's television show Faking it.[148]

Events

International Transgender Day of Visibility

International Transgender Day of Visibility is an annual holiday occurring on March 31[149][150] dedicated to celebrating transgender people and raising awareness of discrimination faced by transgender people worldwide. The holiday was founded by Michigan-based transgender activist[151] Rachel Crandall in 2009[152] as a reaction to the lack of LGBT holidays celebrating transgender people, citing the frustration that the only well-known transgender-centered holiday was the Transgender Day of Remembrance which mourned the loss of transgender people to hate crimes, but did not acknowledge and celebrate living members of the transgender community.

Transgender Awareness Week

Transgender Awareness Week, which is typically observed the first two full weeks of November, is a two week long celebration generally leading up to Transgender Day of Remembrance. The purpose of Transgender Awareness Week is to educate about transgender and gender non-conforming people and the issues associated with their transition or identity.

Trans March

Trans March describes annual marches, protests or gatherings that take place around the world, often taking place during the time of the local pride week. These events are frequently organized by transgender communities to build community, address human rights struggles, and create visibility.

Pride symbols

A common symbol for the transgender community is the Transgender Pride flag, which was designed by Monica Helms, and was first shown at a pride parade in Phoenix, Arizona, United States in 2000.

The flag consists of five horizontal stripes, two light blue, two pink, with a white stripe in the center.

Helms describes the meaning of the flag as follows:

The light blue is the traditional color for baby boys, pink is for girls, and the white in the middle is for "those who are transitioning, those who feel they have a neutral gender or no gender", and those who are intersex. The pattern is such that "no matter which way you fly it, it will always be correct. This symbolizes us trying to find correctness in our own lives." [154]

Other transgender symbols include the butterfly (symbolizing transformation or metamorphosis), and a pink/light blue yin and yang symbol.

Several gender symbols have been used to represent transgender people, including ⚥ and ⚧.

Notes

^*In April 1970, TV Guide published an article which referenced a post-operative transsexual movie character as being "transgendered."("Sunday Highlights". TV Guide. April 26, 1970. Retrieved 28 May 2012. [R]aquel Welch (left), moviedom's sex queen soon to be seen as the heroine/hero of Gore Vidal's transgendered "Myra Breckinridge"...)

In the 1974 edition of Clinical Sexuality: A Manual for the Physician and the Professions, transgender was used as an umbrella term and the Conference Report from the 1974 "National TV.TS Conference" held in Leeds, West Yorkshire, UK used "trans-gender" and "trans.people" as umbrella terms.(Oliven, John F. (1974). Clinical sexuality: A Manual for the Physician and the Professions (3rd ed.). University of Michigan (digitized Aug 2008): Lippincott. pp. 110, 484–487. ISBN978-0-397-50329-2. "Transgender deviance" p 110, "Transgender research" p 484, "transgender deviates" p 485, Transvestites not welcome at "Transgender Center" p 487), (2006). The Transgender Phenomenon (Elkins, Richard; King, Dave (2006). The Transgender Phenomenon. Sage. p. 13. ISBN978-0-7619-7163-4.)

However A Practical Handbook of Psychiatry (1974) references "transgender surgery" noting, "The transvestite rarely seeks transgender surgery, since the core of his perversion is an attempt to realize the fantasy of a phallic woman."(Novello, Joseph R. (1974). A Practical Handbook of Psychiatry. University of Michigan, digitized August 2008: C. C. Thomas. p. 176. ISBN978-0-398-02868-8.)

^Magnus Hirschfeld coined the German term "Transsexualismus" in 1923, which Cauldwell translated into English.

^ abCraig J. Forsyth, Heith Copes (2014). Encyclopedia of Social Deviance. Sage Publications. p. 740. ISBN1483364690. Retrieved April 12, 2016. Transgender is an umbrella term for people whose gender identities, gender expressions, and/or behaviors are different from those culturally associated with the sex to which they were assigned at birth.CS1 maint: Uses authors parameter (link)

^ abB Bilodeau, Beyond the gender binary: A case study of two transgender students at a Midwestern research university, in the Journal of Gay & Lesbian Issues in Education (2005): "Yet Jordan and Nick represent a segment of transgender communities that have largely been overlooked in transgender and student development research – individuals who express a non-binary construction of gender[.]"

^ abSusan Stryker, Stephen Whittle, The Transgender Studies Reader (ISBN 1-135-39884-4), page 666: "The authors note that, increasingly, in social science literature, the term "third gender" is being replaced by or conflated with the newer term "transgender."

^ abJoan C. Chrisler, Donald R. McCreary, Handbook of Gender Research in Psychology, volume 1 (2010, ISBN 1-4419-1465-X), page 486: "Transgender is a broad term characterized by a challenge of traditional gender roles and gender identity[. ...] For example, some cultures classify transgender individuals as a third gender, thereby treating this phenomenon as normative."

^ abReisner, Sari L.; Conron, Kerith; Mimiaga, Matthew J.; Haneuse, Sebastien; et al. (2014). ", Comparing in-person and online survey respondents in the US National Transgender Discrimination Survey: implications for transgender health research". LGBT Health. 1 (2): 98–106. doi:10.1089/lgbt.2013.0018. Transgender was defined broadly to cover those who transition from one gender to another as well as those who may not choose to socially, medically, or legally fully transition, including cross-dressers, people who consider themselves to be genderqueer, androgynous, and ...CS1 maint: Explicit use of et al. (link)

^Oliven, John F. (1965). Sexual Hygiene and Pathology. p. 514. Where the compulsive urge reaches beyond female vestments, and becomes an urge for gender ("sex") change, transvestism becomes "transsexualism." The term is misleading; actually, "transgenderism" is what is meant, because sexuality is not a major factor in primary transvestism. Psychologically, the transsexual often differs from the simple cross-dresser; he is conscious at all times of a strong desire to be a woman, and the urge can be truly consuming.

^ abcThomas E. Bevan, The Psychobiology of Transsexualism and Transgenderism (2014, ISBN 1-4408-3127-0), page 42: "The term transsexual was introduced by Cauldwell (1949) and popularized by Harry Benjamin (1966) [...]. The term transgender was coined by John Oliven (1965) and popularized by various transgender people who pioneered the concept and practice of transgenderism. It is sometimes said that Virginia Prince (1976) popularized the term, but history shows that many transgender people adovcated the use of this term much more than Prince."

^Stryker, S. (2004), "... lived full-time in a social role not typically associated with their natal sex, but who did not resort to genital surgery as a means of supporting their gender presentation ..." in Transgender from the GLBTQ: an encyclopedia of gay, lesbian, bisexual, transgender and queer culture. Retrieved 2007-04-10.

^"First International Conference on Transgender Law and Employment Policy (1992)". organizational pamphlet. ICTLEP/. 1992. Retrieved 28 May 2012. Transgendered persons include transsexuals, transgenderists, and other crossdressers of both sexes, transitioning in either direction (male to female or female to male), of any sexual orientation, and of all races, creeds, religions, ages, and degrees of physical impediment.

^ abGay and Lesbian Alliance Against Defamation. "GLAAD's Transgender Resource Page", "GLAAD", USA. Retrieved 2011-02-24. "Problematic: "transgendered". Preferred: transgender. The adjective transgender should never have an extraneous "-ed" tacked onto the end. An "-ed" suffix adds unnecessary length to the word and can cause tense confusion and grammatical errors. It also brings transgender into alignment with lesbian, gay, and bisexual. You would not say that Elton John is "gayed" or Ellen DeGeneres is "lesbianed," therefore you would not say Chaz Bono is "transgendered."

^A. C. Alegria, Transgender identity and health care: Implications for psychosocial and physical evaluation, in the Journal of the American Academy of Nurse Practitioners, volume 23, issue 4 (2011), pages 175–182: "Transgender, Umbrella term for persons who do not conform to gender norms in their identity and/or behavior (Meyerowitz, 2002). Transsexual, Subset of transgenderism; persons who feel discordance between natal sex and identity (Meyerowitz, 2002)."

^For example, Virginia Prince used transgender to distinguish cross-dressers from transsexual people ("glbtq > social sciences >> Prince, Virginia Charles". glbtq.com.), writing in Men Who Choose to Be Women (in Sexology, February 1969) that "I, at least, know the difference between sex and gender and have simply elected to change the latter and not the former."

^"Sex -- Medical Definition". medilexicon.com.: defines sex as a biological or physiological quality, while gender is a (psychological) "category to which an individual is assigned by self or others...".

^R Polly, J Nicole, Understanding the transsexual patient: culturally sensitive care in emergency nursing practice, in the Advanced Emergency Nursing Journal (2011): "The use of terminology by transsexual individuals to self-identify varies. As aforementioned, many transsexual individuals prefer the term transgender, or simply trans, as it is more inclusive and carries fewer stigmas. There are some transsexual individuals[,] however, who reject the term transgender; these individuals view transsexualism as a treatable congenital condition. Following medical and/or surgical transition, they live within the binary as either a man or a woman and may not disclose their transition history."

^A Swenson, Medical Care of the Transgender Patient, in Family Medicine (2014): "While some transsexual people still prefer to use the term to describe themselves, many transgender people prefer the term transgender to transsexual."

^Parker, Jerry (October 18, 1979). "Christine Recalls Life as Boy from the Bronx". Newsday/Winnipeg Free Press. Retrieved 28 May 2012. If you understand trans-genders," she says, (the word she prefers to transsexuals), "then you understand that gender doesn’t have to do with bed partners, it has to do with identity.

^"News From California: 'Transgender'". Appeal-Democrat/Associate Press. May 11, 1982. pp. A–10. Retrieved 28 May 2012. she describes people who have had such operations’ "transgender" rather than transsexual. "Sexuality is who you sleep with, but gender is who you are," she explained

^Kelley Winters, "Gender Madness in American Psychiatry, essays from the struggle for dignity, 2008, p. 198. "Some Transsexual individuals also identify with the broader transgender community; others do not."

^Boyd, Hellen. "The Umbrella". enGender. Retrieved 28 June 2012. the only part of the gender binary we *necessarily* challenge is the notion that people are always assigned to the right side of the binary at birth, and don’t need sympathy or help if the assignment goes wrong.

^Amy McCrea, Under the Transgender Umbrella: Improving ENDA's Protections, in the Georgetown Journal of Gender and the Law (2013): "This article will begin by providing a background on transgender people, highlighting the experience of a subset of non-binary individuals, bigender people, ..."

^Green, E., Peterson, E.N. (2006) "...The preferred term is 'cross-dresser', but the term 'transvestite' is still used in a positive sense in England..." in LGBTTSQI Terminology from Trans-Academics.org. Retrieved 2007-08-13.

^ abAPA task force (1994) "...The paraphiliac focus of Transvestic Fetishism involves cross-dressing. Usually the male with Transvestic Fetishism keeps a collection of female clothes that he intermittently uses to cross-dress. While cross dressed, he usually masturbates..." in DSM-IV: Sections 302.3 published by the American Psychiatric Association. Retrieved 2007-08-13.

^Tobin, H.J. (2003) "...It has become more and more clear that trans people come in more or less the same variety of sexual orientations as non-trans people..." Sexual Orientation from Sexuality in Transsexual and Transgender Individuals.

^APA task force (1994) "...For sexually mature individuals, the following specifiers may be noted based on the individual's sexual orientation: Sexually Attracted to Males, Sexually Attracted to Females, Sexually Attracted to Both, and Sexually Attracted to Neither..." in DSM-IV: Sections 302.6 and 302.85 published by the American Psychiatric Association. Retrieved via Mental Health Matters on 2007-04-06.

^Goethals, S.C. and Schwiebert, V.L. (2005) "...counselors to rethink their assumptions regarding gender, sexuality and sexual orientation. In addition, they supported counselors' need to adopt a transpositive disposition to counseling and to actively advocate for transgendered persons..." Counseling as a Critique of Gender: On the Ethics of Counseling Transgendered Clients from the International Journal for the Advancement of Counselling, Vol. 27, No. 3, September 2005. Retrieved via SpringerLink on 2007-04-06.

^Harrison, F. (2005) "...He shows me the book in Arabic in which, 41 years ago, Ayatollah Khomeini wrote about new medical issues like transsexuality. "I believe he was the first Islamic scientist in the world of Islam who raised the issue of sex change," says Hojatulislam Kariminia. The Ayatollah's ruling that sex-change operations were allowed has been reconfirmed by Iran's current spiritual leader..." in Iran's sex-change operations, from the BBC. Retrieved 2007-07-22.

^Haviland, C. (2005) "...The Gurung people of western Nepal have a tradition of men called maarunis, who dance in female clothes..." in Crossing sexual boundaries in Nepal, from the BBC. Retrieved 2007-07-22.

^Shim, S. (2006) "...Rush, catering especially to crossdressers and transgenders, is a cafe owned by a 46-year-old man who goes by the female name Lee Cho-rong. "...Many people in South Korea don't really understand the difference between gay and transgender. I'm not gay. I was born a man but eager to live as a woman and be beautiful," said Lee..." in S. Korea in dilemma over transgender citizens right to choose from the Yonhap News Agency. Retrieved 2007-07-22.

^Heng, R. (2005) "...Even if we take Bugis Street as a starting point, we should remember that cross-dressing did not emerge suddenly out of nowhere. Across Asia, there is a tradition of cross-dressing and other forms of transgender behaviour in many places with a rich local lexicon and rituals associated with them...." in Where queens ruled! - a history of gay venues in Singapore from IndigNation. Retrieved 2007-07-22.

^Wang, Z. and Xie, F. (2006) "...While it is true that not everyone turns into a drag queen when they are feeling stressed out, many young people do seem to be caught up in the fad of androgyny..." in Cross-dressers captivate people across China from China Daily. Retrieved 2007-07-22.

^Goldkorn, J. (2006) "...At one point in 2003, there was so much media coverage of transsexuals in China that Danwei started a special section for it..." in Transsexuals in the Chinese media again from Danwei. Retrieved 2007-07-22.